Associate Medical Director DME

BlueCross BlueShield of South Carolina • Detroit, MI • 10h ago

Internal Reference Number: R1048061 Summary Why should you join the BlueCross BlueShield of South Carolina family of companies?

Other companies come and go, but we've been part of the national landscape for more than seven decades, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina ... and much more. We are one of the nation's leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies, allowing us to build on various business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!

Position Purpose:

As member of the Pricing, Data Analysis and Coding (PDAC) team, the Associate Medical Director DME provides administrative oversight to the medical staff, analyzes medical review utilization data, researches new medical devices and technology, and acts as a resource to CMS, DMEPOS stakeholders, internal staff, on issues concerning medical device coding and DMEPOS policies. In this role, you will also oversee coding integrity efforts as well as write and revise coding advisory articles with regard to Medicare policy and procedure.Description Logistics: Palmetto GBA - one of BlueCross BlueShield's South Carolina subsidiary companies.

Location: This position is full-time (40-hours/week) Monday-Friday. You will work an 8-hour shift scheduled during our normal business hours of 8:00AM-5:00PM. It may be necessary, given the business need to work occasional overtime. This role is located at our Government Programs Building at 17 Technology Circle, Columbia, SC OR can be REMOTE in the United States. There will be required travel for this position.

Government Clearance: This position requires the ability to obtain a security clearance, which requires applicants to be a U.S. Citizen.

What You'll Do:

Supports operations in the form of case review on both medical and regulatory matters.

Develops claim adjudication criteria for situations requiring medical judgment.

Provides input on issues and operational policies, processes, and procedures.

Educates staff and medical community on various aspects of medical policy and program administration.

May develop and update medical policy in consultation with appropriate regulatory personnel, medical consultants, and professional societies.

Develops external relationships with the medical community and serves as liaison between these entities and the contractors.

Reviews physician and provider practice pattern analysis and other statistical data related to unusual medical service utilization.

Conducts research into new or controversial medical procedures and technology.

To Qualify for This Position, You'll Need the Following:

Required Education: Doctoral degree Medical Doctor (MD) with current active license to practice medicine.

Required Experience:

Five years post graduate experience in direct patient care.

Required Skills and Abilities:

Excellent verbal and written communication skills.

Excellent customer service, organizational, and presentation skills.

Proficiency in spelling, punctuation, and grammar.

Ability to persuade, negotiate, or influence others.

Ability to work as a team member as well as a leader.

Knowledge of medical and utilization review techniques.

Required Software : Microsoft Office Software

Required License and Certificate: Active state medical license and current board certification in a recognized specialty.

We Prefer That You Have the Following:

Certified Professional Coding is preferred

Knowledge of Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS)

Medicare A/B MAC

Similar Jobs

Telemedicine Physician

QuickMD • Garden City, MI • 56min ago

Hospital & Medical Sponsored

About QuickMD: QuickMD is a leading telemedicine provider, delivering high-quality virtual care across 44 states. Since our founding in 2019, we have helped more than 100,000 patients access essential medical treatment,...

56min ago

Go to Apply

Vascular Access Nurse

All-Stat Portable • Detroit, MI • 1h ago

Hospital & Medical

Job Description: All-Stat PICC Line is currently seeking a full-time Vascular Access/PICC Line Registered Nurse for our Vascular Access Team. The Vascular Nurse provides vascular access device insertion and care and main...

1h ago

Go to Apply

2026 College Intern - IT (in person Troy, MI) - Health Alliance Plan

Henry Ford Health System • Troy, MI • 3h ago

Hospital & Medical

Health Alliance Plan (HAP) is seeking motivated and talented individuals to join our Information Technology (IT) team as interns for the Summer 2026 Intern Program. The full-time program will run May 11 - August 7, with...

3h ago

Go to Apply

Registered Dietitian (RD)

Ciena Healthcare Management • Troy, MI • 10h ago

Hospital & Medical

Sign-On Bonus! - $10,000 (paid out quarterly) Are you passionate about food and nutrition and ensuring seniors have delicious, healthy meals? As a Registered Dietitian (RD) at Regency at Troy, you have the opportunity to...

10h ago

Go to Apply

Hospice Registered Nurse

Gentiva • Clinton Township, MI • 1d ago

Hospital & Medical

Overview Lead with Heart. Be the Difference. Transform End-of-Life Care. Join our company, where every day is an opportunity to deliver personalized, meaningful hospice and palliative care to patients facing life-limitin...

1d ago

Go to Apply

Medical Laboratory Scientist II

Quest Diagnostics Inc • Grosse Pointe Woods, MI • 1d ago

Hospital & Medical

Job Description Medical Laboratory Scientist II - Grosse Point, MI, On-Call; Sunday - Saturday 3:00pm-11:30pm; schedule varies; weekends as needed employee may be eligible to receive shift differential of 10% for some or...

1d ago

Go to Apply

Director Managed Care and Marketing

Fresenius Medical Care North America • Detroit, MI • 1d ago

Hospital & Medical

PURPOSE AND SCOPE: Directs organization's activities of strategic planning, evaluation, coordination, and implementation of various managed health care programs (HMOs, PPOs, POS, etc). Oversees Division's contractual rel...

1d ago

Go to Apply

Accounting Manager- Healthcare Risk & Non-Claim Benefit Expense Contracts

Blue Cross Blue Shield of Michigan • Detroit, MI • 1d ago

Hospital & Medical

We are seeking a highly skilled and strategic Accounting Manager to lead complex accounting operations related to healthcare facility and provider contracts, with a focus on Non-Claim Benefit Expenses (NCBE), Medical Los...

1d ago

Go to Apply

Research Assistant - Department of Family Medicine and Public Health Sciences

Wayne State University • Detroit, MI • 1d ago

Hospital & Medical

Research Assistant - Department of Family Medicine and Public Health Sciences Wayne State University is searching for an experiencedResearch Assistant - Department of Family Medicine and Public Health Sciencesat its Detr...

1d ago

Go to Apply

Medical Laboratory Scientist II

Quest Diagnostics Inc • Dearborn, MI • 2d ago

Hospital & Medical

Job Description Medical Laboratory Scientist - Dearborn, MI Hiring for multiple shifts and departments. Apply to connect with a recruiter and learn more! Perform test procedures of moderate/high complexity requiring the...

2d ago

Go to Apply

Subscribe to get new jobs sent directly to you
(no charge, cancel anytime)

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.